A. Niedermeier

Bekou V

Bruch-Gerharz D

Brunsting LA

Chan LS

Choi GS

Daito J

H. Jedlickova

Joly P

Kurzhals G

Lazarova Z

M. Hertl

Monihan JM

Murata Y

Poon E

S. Zgažarová

Tasanen K

English

Crossref

Dermatology

Brunsting-Perry Pemphigoid of the Scalp with Antibodies against Laminin 332

Jedlickova, H.

Niedermeier, A.

Zgazarova, S.

Hertl, M.

Universität München: Elektronischen Publikationen

Fax +41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com
 Letter to Dermatology 
  3 - and   2 -chains from the squamous carcinoma cell line SCC25), 
recombinant 230-kDa BP antigen (BP230) and 180-kDa BP anti-
gen (BP180; baculoprotein expression system) as previously de-
scribed  [4] . By ELISA, there was strong IgG reactivity against 
laminin 332 and reactivity against a distinct BP180 epitope (mid-
portion of the BP180 ectodomain, aa residues 809–1106). The le-
sion healed with topical corticosteroids. Three years later, the 
patient was in complete remission, and a control ELISA no longer 
showed IgG reactivity against laminin 332, BP180 or BP230 an-
tigens.
 Case 2 
 A 74-year-old man had a 2-year history of erosions and crusts 
of the scalp. At presentation, he had an erosive and crusty lesion 
10 cm in diameter on the top of his head while other parts of the 
body or mucous membranes were not affected ( fig. 1 b). The bi-
opsy showed actinic damage of the epidermis; the diagnosis of 
actinic keratosis was established, and the lesion was treated with 
liquid nitrogen with only temporary effect. A second biopsy of 
lesional skin showed subepidermal cleavage and an inflammatory 
infiltrate composed of lymphocytes and histiocytes in the dermis 
suggestive of CP ( fig. 1 c). DIF of lesional skin was negative, IIF on 
monkey oesophagus showed granular antinuclear auto-antibod-
ies at a titre of 1: 80 and weak linear positivity with anti-IgG, -A 
and -M antibodies; salt split skin was negative. By ELISA, the pa-
tient’s serum showed IgG reactivity against laminin 332. Topical 
treatment with corticosteroids led to a temporary healing of the 
lesion. Two years later, the patient still needs intermittent topical 
corticosteroid treatment.
 Discussion 
 Brunsting-Perry pemphigoid typically affects elderly men as 
multiple erosive and scarring lesions in the head and neck region, 
rarely as a solitary plaque  [5] . In case of a solitary lesion the diag-
nosis may be extremely difficult. These cases can be misdiag-
nosed as actinic keratosis, pyoderma or dermatitis artefacta. The 
lesion is often eroded; thus, no subepidermal blister is detected, 
eosinophils are usually absent, immunofluorescence studies, if 
done, can be negative.
 A case of Brunsting-Perry pemphigoid similar to ours with a 
solitary lesion of the scalp was described by Poon and McGrath 
 [6] , which was negative by DIF and IIF. Monihan et al. [7] de-
scribed 3 cases of CP simulating basal cell carcinoma. Murata et 
al.  [8] detected immunoglobulin deposits between basal keratino-
cytes and the lamina lucida of the dermal-epidermal junction by 
immuno-electron microscopy in a case of Brunsting-Perry pem-
phigoid supporting the concept that this disorder is closely re-
lated to CP.
 Key Words 
 Auto-immune bullous diseases   Brunsting-Perry 
pemphigoid   Cicatricial pemphigoid   Laminin 332 
 A scarring disease localized to the head and neck without mu-
cosal involvement, described by Brunsting and Perry in 1957  [1] , 
is considered as a variant of cicatricial pemphigoid (CP), bullous 
pemphigoid (BP) or epidermolysis bullosa acquisita (EBA), al-
though the target antigen has not yet been clearly established. In 
this report, we describe 2 patients with localized CP of the scalp 
and IgG auto-antibodies against laminin 332. Laminin 332 (for-
merly laminin 5) is a target antigen of one subset of CP affecting 
mucous membranes (mucous membrane pemphigoid, MMP)  [2] . 
It is considered rather specific for this subset of MMP and is de-
tected rarely in subepidermal bullous dermatoses affecting the 
skin  [3] .
 Case 1 
 A 58-year-old man presented with a 2-year history of a scar-
ring and crusty lesion 3 cm in diameter in the parietal scalp re-
gion. Basal cell carcinoma was suspected, and a biopsy of the le-
sion was performed. Histological examination showed erosion 
with an inflammatory infiltrate and a few yeast cells (Grocott 
stain). However, topical therapy with antibiotics and antimycot-
ics was not effective. A second skin biopsy revealed subepidermal 
cleavage, erythrocytes in the blister and an inflammatory der-
mal infiltrate of lymphocytes and histiocytes suggestive of CP 
( fig. 1 a). Direct immunofluorescence microscopy (DIF) of lesion-
al skin showed weak linear positivity with anti-IgG antibody; 
indirect immunofluorescence (IIF) on monkey oesophagus was 
negative. A salt split skin test was not performed. Eventually, en-
zyme-linked immunosorbent assay (ELISA) was performed with 
native human laminin 332 (affinity-purified protein with   3 -, 
 Published online: January 11, 2011 
 © 2011 S. Karger AG, Basel 
 Accessible online at:
www.karger.com/drm 
 Dermatology 2011;222:193–195 
 DOI: 10.1159/000322842 
 Brunsting-Perry Pemphigoid of the Scalp with 
Antibodies against Laminin 332 
 H. Jedlickova  a , A. Niedermeier  b , S. Zgažarová  a , M. Hertl  c 
 a   First Department of Dermatovenereology, St. Anna Hospital, 
Masaryk University,  Brno , Czech Republic;  b   Department of 
Dermatology and Allergology, Ludwig Maximilian University 
Munich,  Munich , and  c   Department of Dermatology and 
Allergology, Philipps University,  Marburg , Germany 
 Letter to Dermatology  194
 Kurzhals et al.  [9] described a case with clinical features of 
Brunsting-Perry pemphigoid with an immunofluorescence and 
immuno-electron microscopy pattern identical to EBA. This 
finding has also been reported by others  [10, 11] .
 Daito et al.  [12] have recently detected IgG auto-antibodies 
against the COOH terminus of BP180 by immunoblot and bor-
derline positivity of auto-antibodies against the BP180 NC16a do-
main by ELISA in a woman with Brunsting-Perry pemphigoid of 
the scalp and upper trunk involvement. Antibodies against lam-
inin 332 have not been reported in association with Brunsting-
Perry pemphigoid, yet. ELISA is a sensitive and specific tool for 
the detection of anti-laminin-332 antibodies. In the study of Be-
kou et al.  [13] , ELISA with native laminin 332 in MMP had a sen-
sitivity of 75% and a specificity of 84.3%. Bekou et al.  [13] also 
detected anti-laminin-332 antibodies in 40% of patients with BP. 
Anti-laminin-332 antibodies can occur in BP and CP due to the 
epitope spreading phenomenon; laminin 332 is a ligand for BP180 
 [14] , and the BP180 COOH terminus is considered as a target an-
tigen in CP.
 In conclusion, our 2 patients presented here strongly suggest 
that CP of the head, neck and upper trunk without mucosal in-
volvement is a heterogeneous disorder with several target anti-
gens. In addition to the auto-antigens of EBA and BP, IgG auto-
antibodies against a major auto-antigen of MMP, laminin 332, 
may play an important pathogenetic role, especially in the solitary 
lesions of the scalp. Further studies are needed to confirm the rel-
evance of anti-laminin-332 antibodies in Brunsting-Perry pem-
phigoid.
 Disclosure Statement 
 The authors have no conflict of interest to declare. 
a b
c
 Fig. 1.  a Subepidermal blister, case 1. Haematoxylin-eosin. Origi-
nal magnification  ! 100.  b Crusts and erosion on the top of the 
head, case 2.  c Denuded dermis with remnants of epidermis, sub-
epidermal cleft, case 2. Haematoxylin-eosin. Original magnifica-
tion  ! 200. 
Co
lo
r v
er
si
on
 a
va
ila
bl
e 
on
lin
e
195 Letter to Dermatology 
 References 
 1 Brunsting LA, Perry HO: Benign pemphigoid? A report of seven cases 
with chronic, scarring, herpetiform plaques about the head and neck. 
Arch Dermatol 1957; 75: 489–501. 
 2 Chan LS, Ahmed AR, Anhalt GJ, Bernauer W, Cooper KD, Elder MJ, 
Fine JD, Foster CS, Ghohestani R, Hashimoto T, Hoang-Xuan T, 
Kirtschig G, Korman NJ, Lightman S, Lozada-Nur F, Marinkovich MP, 
Mondino BJ, Prost-Squarcioni C, Rogers RS 3rd, Setterfield JF, West 
DP, Wojnarowska F, Woodley DT, Yancey KB, Zillikens D, Zone JJ: The 
first international consensus on mucous membrane pemphigoid: defi-
nition, diagnostic criteria, pathogenic factors, medical treatment, and 
prognostic indicators. Arch Dermatol 2002; 138: 370–379. 
 3 Lazarova Z, Salato VK, Lanschuetzer CM, Janson M, Fairley JA, Yan-
cey KB: IgG anti-laminin-332 autoantibodies are present in a subset of 
patients with mucous membrane, but not bullous, pemphigoid. J Am 
Acad Dermatol 2008; 58: 951–958. 
 4 Thoma-Uszynski S, Uter W, Schwietzke S, Schuler G, Borradori L, 
Hertl M: Autoreactive T and B cells from bullous pemphigoid (BP) pa-
tients recognize epitopes clustered in distinct regions of BP180 and 
BP230.  J Immunol  2006; 176: 2015–2023. 
 5 Bruch-Gerharz D, Hertl M, Ruzicka T: Mucous membrane pemphi-
goid: clinical aspects, immunopathological features and therapy. Eur J 
Dermatol 2007; 17: 191–200. 
 6 Poon E, McGrath JA: Non-specific scalp crusting as a presenting fea-
ture of Brunsting-Perry cicatricial pemphigoid. J Eur Acad Dermatol 
Venereol 1999; 12: 177–178. 
 7 Monihan JM, Nguyen TH, Guill MA: Brunsting-Perry pemphigoid 
simulating basal cell carcinoma. J Am Acad Dermatol 1989; 21: 331–334. 
 8 Murata Y, Tani M, Kumano K: Localized chronic pemphigoid of 
Brunsting Perry: ultrastructural localization of IgG and complement 
components. Arch Dermatol 1983; 119: 921–924. 
 9 Kurzhals G, Stolz W, Meurer M, Kunze J, Braun-Falco O, Krieg T: Ac-
quired epidermolysis bullosa with the clinical feature of Brunsting-
Perry cicatricial bullous pemphigoid. Arch Dermatol 1991; 127: 391–
395. 
 10 Joly P, Ruto F, Thomine E, Delpech A, Balguerie X, Tron F, Lauret P: 
Brunsting-Perry cicatricial bullous pemphigoid: a clinical variant of 
localized acquired epidermolysis bullosa? J Am Acad Dermatol 1993; 
 28: 89–92. 
 11 Choi GS, Lee ES, Kim SC, Lee S: Epidermolysis bullosa acquisita local-
ized to the face. J Dermatol 1998; 25: 19–22. 
 12 Daito J, Katoh N, Asai J, Ueda E, Takenaka H, Ishii N, Hashimoto T, 
Kishimoto S: Brunsting-Perry cicatricial pemphigoid associated with 
autoantibodies to the C-terminal domain of BP180. Br J Dermatol 2008; 
 159: 984–986. 
 13 Bekou V, Thoma-Uszynski S, Wendler O, Uter W, Schwietzke S, Hun-
ziker T, Zouboulis CC, Schuler G, Sorokin L, Hertl M: Detection of 
laminin 5-specific auto-antibodies in mucous membrane and bullous 
pemphigoid sera by ELISA. J Invest Dermatol 2005; 124: 732–740. 
 14 Tasanen K, Tunggal L, Chometon G, Bruckner-Tuderman L, Aumailley 
M: Keratinocytes from patients lacking collagen XVII display a migra-
tory phenotype. Am J Pathol 2004; 164: 2027–2038. 
 
 H. Jedlickova 
 First Department of Dermatovenereology 
 St. Anna Hospital, Masaryk University 
 CZ–65691 Brno (Czech Republic) 
 Tel. +420 543 182 813, Fax +420 543 182 793
E-Mail hana.jedlickova   @   fnusa.cz 


Open Access LMU ( Ludwig-Maximilians-Univ. München)

Fax +41 61 306 12 34E-Mail karger@karger.chwww.karger.com Letter to Dermatology   3 - and   2 -chains from the squamous carcinoma cell line SCC25), recombinant 230-kDa BP antigen (BP230) and 180-kDa BP anti-gen (BP180; baculoprotein expression system) as previously de-scribed  [4] . By ELISA, there was strong IgG reactivity against laminin 332 and reactivity against a distinct BP180 epitope (mid-portion of the BP180 ectodomain, aa residues 809–1106). The le-sion healed with topical corticosteroids. Three years later, the patient was in complete remission, and a control ELISA no longer showed IgG reactivity against laminin 332, BP180 or BP230 an-tigens. Case 2  A 74-year-old man had a 2-year history of erosions and crusts of the scalp. At presentation, he had an erosive and crusty lesion 10 cm in diameter on the top of his head while other parts of the body or mucous membranes were not affected ( fig. 1 b). The bi-opsy showed actinic damage of the epidermis; the diagnosis of actinic keratosis was established, and the lesion was treated with liquid nitrogen with only temporary effect. A second biopsy of lesional skin showed subepidermal cleavage and an inflammatory infiltrate composed of lymphocytes and histiocytes in the dermis suggestive of CP ( fig. 1 c). DIF of lesional skin was negative, IIF on monkey oesophagus showed granular antinuclear auto-antibod-ies at a titre of 1: 80 and weak linear positivity with anti-IgG, -A and -M antibodies; salt split skin was negative. By ELISA, the pa-tient’s serum showed IgG reactivity against laminin 332. Topical treatment with corticosteroids led to a temporary healing of the lesion. Two years later, the patient still needs intermittent topical corticosteroid treatment. Discussion  Brunsting-Perry pemphigoid typically affects elderly men as multiple erosive and scarring lesions in the head and neck region, rarely as a solitary plaque  [5] . In case of a solitary lesion the diag-nosis may be extremely difficult. These cases can be misdiag-nosed as actinic keratosis, pyoderma or dermatitis artefacta. The lesion is often eroded; thus, no subepidermal blister is detected, eosinophils are usually absent, immunofluorescence studies, if done, can be negative. A case of Brunsting-Perry pemphigoid similar to ours with a solitary lesion of the scalp was described by Poon and McGrath  [6] , which was negative by DIF and IIF. Monihan et al. [7] de-scribed 3 cases of CP simulating basal cell carcinoma. Murata et al.  [8] detected immunoglobulin deposits between basal keratino-cytes and the lamina lucida of the dermal-epidermal junction by immuno-electron microscopy in a case of Brunsting-Perry pem-phigoid supporting the concept that this disorder is closely re-lated to CP. Key Words  Auto-immune bullous diseases   Brunsting-Perry pemphigoid   Cicatricial pemphigoid   Laminin 332  A scarring disease localized to the head and neck without mu-cosal involvement, described by Brunsting and Perry in 1957  [1] , is considered as a variant of cicatricial pemphigoid (CP), bullous pemphigoid (BP) or epidermolysis bullosa acquisita (EBA), al-though the target antigen has not yet been clearly established. In this report, we describe 2 patients with localized CP of the scalp and IgG auto-antibodies against laminin 332. Laminin 332 (for-merly laminin 5) is a target antigen of one subset of CP affecting mucous membranes (mucous membrane pemphigoid, MMP)  [2] . It is considered rather specific for this subset of MMP and is de-tected rarely in subepidermal bullous dermatoses affecting the skin  [3] . Case 1  A 58-year-old man presented with a 2-year history of a scar-ring and crusty lesion 3 cm in diameter in the parietal scalp re-gion. Basal cell carcinoma was suspected, and a biopsy of the le-sion was performed. Histological examination showed erosion with an inflammatory infiltrate and a few yeast cells (Grocott stain). However, topical therapy with antibiotics and antimycot-ics was not effective. A second skin biopsy revealed subepidermal cleavage, erythrocytes in the blister and an inflammatory der-mal infiltrate of lymphocytes and histiocytes suggestive of CP ( fig. 1 a). Direct immunofluorescence microscopy (DIF) of lesion-al skin showed weak linear positivity with anti-IgG antibody; indirect immunofluorescence (IIF) on monkey oesophagus was negative. A salt split skin test was not performed. Eventually, en-zyme-linked immunosorbent assay (ELISA) was performed with native human laminin 332 (affinity-purified protein with   3 -,  Published online: January 11, 2011  © 2011 S. Karger AG, Basel  Accessible online at:www.karger.com/drm  Dermatology 2011;222:193–195  DOI: 10.1159/000322842  Brunsting-Perry Pemphigoid of the Scalp with Antibodies against Laminin 332  H. Jedlickova  a , A. Niedermeier  b , S. Zgažarová  a , M. Hertl  c  a   First Department of Dermatovenereology, St. Anna Hospital, Masaryk University,  Brno , Czech Republic;  b   Department of Dermatology and Allergology, Ludwig Maximilian University Munich,  Munich , and  c   Department of Dermatology and Allergology, Philipps University,  Marburg , Germany  Letter to Dermatology  194 Kurzhals et al.  [9] described a case with clinical features of Brunsting-Perry pemphigoid with an immunofluorescence and immuno-electron microscopy pattern identical to EBA. This finding has also been reported by others  [10, 11] . Daito et al.  [12] have recently detected IgG auto-antibodies against the COOH terminus of BP180 by immunoblot and bor-derline positivity of auto-antibodies against the BP180 NC16a do-main by ELISA in a woman with Brunsting-Perry pemphigoid of the scalp and upper trunk involvement. Antibodies against lam-inin 332 have not been reported in association with Brunsting-Perry pemphigoid, yet. ELISA is a sensitive and specific tool for the detection of anti-laminin-332 antibodies. In the study of Be-kou et al.  [13] , ELISA with native laminin 332 in MMP had a sen-sitivity of 75% and a specificity of 84.3%. Bekou et al.  [13] also detected anti-laminin-332 antibodies in 40% of patients with BP. Anti-laminin-332 antibodies can occur in BP and CP due to the epitope spreading phenomenon; laminin 332 is a ligand for BP180  [14] , and the BP180 COOH terminus is considered as a target an-tigen in CP. In conclusion, our 2 patients presented here strongly suggest that CP of the head, neck and upper trunk without mucosal in-volvement is a heterogeneous disorder with several target anti-gens. In addition to the auto-antigens of EBA and BP, IgG auto-antibodies against a major auto-antigen of MMP, laminin 332, may play an important pathogenetic role, especially in the solitary lesions of the scalp. Further studies are needed to confirm the rel-evance of anti-laminin-332 antibodies in Brunsting-Perry pem-phigoid. Disclosure Statement  The authors have no conflict of interest to declare. a bc Fig. 1.  a Subepidermal blister, case 1. Haematoxylin-eosin. Origi-nal magnification  ! 100.  b Crusts and erosion on the top of the head, case 2.  c Denuded dermis with remnants of epidermis, sub-epidermal cleft, case 2. Haematoxylin-eosin. Original magnifica-tion  ! 200. Color version available online195 Letter to Dermatology  References  1 Brunsting LA, Perry HO: Benign pemphigoid? A report of seven cases with chronic, scarring, herpetiform plaques about the head and neck. Arch Dermatol 1957; 75: 489–501.  2 Chan LS, Ahmed AR, Anhalt GJ, Bernauer W, Cooper KD, Elder MJ, Fine JD, Foster CS, Ghohestani R, Hashimoto T, Hoang-Xuan T, Kirtschig G, Korman NJ, Lightman S, Lozada-Nur F, Marinkovich MP, Mondino BJ, Prost-Squarcioni C, Rogers RS 3rd, Setterfield JF, West DP, Wojnarowska F, Woodley DT, Yancey KB, Zillikens D, Zone JJ: The first international consensus on mucous membrane pemphigoid: defi-nition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators. Arch Dermatol 2002; 138: 370–379.  3 Lazarova Z, Salato VK, Lanschuetzer CM, Janson M, Fairley JA, Yan-cey KB: IgG anti-laminin-332 autoantibodies are present in a subset of patients with mucous membrane, but not bullous, pemphigoid. J Am Acad Dermatol 2008; 58: 951–958.  4 Thoma-Uszynski S, Uter W, Schwietzke S, Schuler G, Borradori L, Hertl M: Autoreactive T and B cells from bullous pemphigoid (BP) pa-tients recognize epitopes clustered in distinct regions of BP180 and BP230.  J Immunol  2006; 176: 2015–2023.  5 Bruch-Gerharz D, Hertl M, Ruzicka T: Mucous membrane pemphi-goid: clinical aspects, immunopathological features and therapy. Eur J Dermatol 2007; 17: 191–200.  6 Poon E, McGrath JA: Non-specific scalp crusting as a presenting fea-ture of Brunsting-Perry cicatricial pemphigoid. J Eur Acad Dermatol Venereol 1999; 12: 177–178.  7 Monihan JM, Nguyen TH, Guill MA: Brunsting-Perry pemphigoid simulating basal cell carcinoma. J Am Acad Dermatol 1989; 21: 331–334.  8 Murata Y, Tani M, Kumano K: Localized chronic pemphigoid of Brunsting Perry: ultrastructural localization of IgG and complement components. Arch Dermatol 1983; 119: 921–924.  9 Kurzhals G, Stolz W, Meurer M, Kunze J, Braun-Falco O, Krieg T: Ac-quired epidermolysis bullosa with the clinical feature of Brunsting-Perry cicatricial bullous pemphigoid. Arch Dermatol 1991; 127: 391–395.  10 Joly P, Ruto F, Thomine E, Delpech A, Balguerie X, Tron F, Lauret P: Brunsting-Perry cicatricial bullous pemphigoid: a clinical variant of localized acquired epidermolysis bullosa? J Am Acad Dermatol 1993;  28: 89–92.  11 Choi GS, Lee ES, Kim SC, Lee S: Epidermolysis bullosa acquisita local-ized to the face. J Dermatol 1998; 25: 19–22.  12 Daito J, Katoh N, Asai J, Ueda E, Takenaka H, Ishii N, Hashimoto T, Kishimoto S: Brunsting-Perry cicatricial pemphigoid associated with autoantibodies to the C-terminal domain of BP180. Br J Dermatol 2008;  159: 984–986.  13 Bekou V, Thoma-Uszynski S, Wendler O, Uter W, Schwietzke S, Hun-ziker T, Zouboulis CC, Schuler G, Sorokin L, Hertl M: Detection of laminin 5-specific auto-antibodies in mucous membrane and bullous pemphigoid sera by ELISA. J Invest Dermatol 2005; 124: 732–740.  14 Tasanen K, Tunggal L, Chometon G, Bruckner-Tuderman L, Aumailley M: Keratinocytes from patients lacking collagen XVII display a migra-tory phenotype. Am J Pathol 2004; 164: 2027–2038.   H. Jedlickova  First Department of Dermatovenereology  St. Anna Hospital, Masaryk University  CZ–65691 Brno (Czech Republic)  Tel. +420 543 182 813, Fax +420 543 182 793E-Mail hana.jedlickova   @   fnusa.cz 

Acquired epidermolysis bullosa with the clinical feature of BrunstingPerry cicatricial bullous pemphigoid. Arch Dermatol

Autoreactive T and B cells from bullous pemphigoid (BP) patients recognize epitopes clustered in distinct regions of BP180 and BP230.

Benign pemphigoid? A report of seven cases with chronic, scarring, herpetiform plaques about the head and neck. Arch Dermatol

Brunsting-Perry cicatricial pemphigoid associated with autoantibodies to the C-terminal domain of BP180.

Brunsting-Perry pemphigoid simulating basal cell carcinoma.

Hertl M: Detection of laminin 5-specific auto-antibodies in mucous membrane and bullous pemphigoid sera by ELISA.

KB: IgG anti-laminin-332 autoantibodies are present in a subset of patients with mucous membrane, but not bullous, pemphigoid.

Keratinocytes from patients lacking collagen XVII display a migratory phenotype.

Lauret P: Brunsting-Perry cicatricial bullous pemphigoid: a clinical variant of localized acquired epidermolysis bullosa? J Am Acad Dermatol

Mucous membrane pemphigoid: clinical aspects, immunopathological features and therapy.

Non-specific scalp crusting as a presenting feature of Brunsting-Perry cicatricial pemphigoid.

S: Epidermolysis bullosa acquisita localized to the face.

The first international consensus on mucous membrane pemphigoid: definition, diagnostic criteria, pathogenic factors, medical treatment, and prognostic indicators. Arch Dermatol

u r a t a Y , T a n i M , K u m a n o K : L o c a l i z e d c h r o n i c p e m p h i g o i d o f Brunsting Perry: ultrastructural localization of IgG and complement components. Arch Dermatol

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Brunsting-Perry Pemphigoid of the Scalp with Antibodies against Laminin 332

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